Abstract The benefits of different surgical approaches for total hip arthroplasty continue to be debated. One hundred patients were prospectively enrolled and randomized into 2 groups. One group ...underwent total hip arthroplasty through a single-incision modified Smith-Peterson approach, whereas the other group underwent total hip arthroplasty through a direct lateral approach. All patients received the same postoperative protocol. Evaluation included operative time, estimated blood loss, analgesia requirement, transfusions, and length of stay. Functional outcome was assessed preoperatively and postoperatively. Up to 1-year follow-up, the direct anterior group demonstrated significantly better improvement in both the mental and physical health dimensions of Short Form-36 and Western Ontario McMaster Osteoarthritis Index compared with direct lateral approach group. At 2 years, the results in both groups were the same.
Abstract Background A certified list of all operative cases performed within a 6-month period is a required prerequisite for surgeons taking the American Board of Orthopaedic Surgery Part II oral ...examination. Using the American Board of Orthopaedic Surgery secure Internet database database containing these cases, this study (1) assessed changing trends for primary and revision total hip arthroplasty (THA) and (2) compared practices and early postoperative complications between 2 groups of examinees, those with and without adult reconstruction fellowship training. Methods Secure Internet database was searched for all 2003-2013 procedures with a Current Procedural Terminology code for THA, hip resurfacing, hemiarthroplasty, revision hip arthroplasty, conversion to THA, or removal of hip implant (Girdlestone, static, or dynamic spacer). Results Adult reconstruction fellowship-trained surgeons performed 60% of the more than 33,000 surgeries identified (average 28.1) and nonfellowship-trained surgeons performed 40% (average 5.2) ( P < .001). Fellowship-trained surgeons performed significantly more revision surgeries for infection (71% vs 29%)( P < .001). High-volume surgeons had significantly fewer complications in both primary (11.1% vs 19.6%) and revision surgeries (29% vs 35.5%) ( P < .001). Those who passed the Part II examination reported higher rates of complications (21.5% vs 19.9%). Conclusion In early practice, primary and revision hip arthroplasties are often performed by surgeons without adult reconstruction fellowship training. Complications are less frequently reported by surgeons with larger volumes of joint replacement surgery who perform either primary or more complex cases. Primary hip arthroplasty is increasingly performed by surgeons early in practice who have completed an adult reconstructive fellowship after residency training. This trend is even more pronounced for more complex cases such as revision or management of infection.
Abstract Background This study used EOS imaging of primary total hip arthroplasty (THA) patients, with and without predating spinal fusion, to investigate (1) the impact of spinal fusion on ...acetabular implant anteversion and inclination, and (2) whether more extensive spinal fusion (fusion starting above the thoracolumbar junction or extension of fusion to sacrum) affects acetabular implant orientation differently than lumbar-only spinal fusion. Methods We retrospectively included all patients who underwent primary THA and had postoperative sitting and standing EOS® imaging. Ninety-three patients had spinal fusion (case group), and 150 patients were without spinal fusion (controls). None of the patients experienced dislocation. The change in sacral slope (SS) and cup orientation from standing to sitting was measured. Results Mean SS change from standing to sitting position was -7.9° in the fusion group compared to -18.4° in controls (p=0.0001). Mean change in cup inclination from standing to sitting was 4.9° in the fusion group compared to 10.2° in controls (p=0.0001). Mean change in cup anteversion from standing to sitting was 7.1° in the fusion group compared to 12.1° in controls (p=0.0001). For each additional level of spinal fusion, the change in SS from standing to sitting decreased by 1.6° (95% CI: 2.2073 to 1.0741), the change in cup inclination decreased by 0.8° (95% CI: 0.380 to 1.203), and the change in cup anteversion decreased by 0.9° (95% CI: 0.518 to 1.352) (p<0.001 in all cases). Conclusions Patients with spinal fusion demonstrated less adaptability of the lumbosacral junction. Longer spinal fusion or inclusion of the pelvis in the fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition.
Abstract Background Optimal implant position is critical to hip stability after total hip arthroplasty (THA). While most hip dislocations occur in either standing or sitting position, the safe zone ...for implant position is defined for the supine position. The goal of this study was to determine preoperative and postoperative pelvis and hip orientations and whether the accepted range for implant orientation proposed as the safe zone in supine position can be used to assess standing radiographs. Methods Preoperative and postoperative three-dimensional EOS® images were assessed in 66 THA patients. None of the patients had dislocation within the follow-up period (12-36 months). The acetabular anteversion both anterior pelvic plane (APP) and patient functional plane (PFP) and the femoral anteversion were measured. The sacral slope, pelvic version, pelvic inclination and pelvic incidence were also measured. Results Acetabular anteversion increased postoperatively in both APP and PFP (p < 0.001). Femoral neck anteversion decreased postoperatively (p = 0.0942). Sacral slope was 42.4° (-25.9° to 24°) preoperatively compared to 40.3° (-4.1° to 64.2°) postoperatively (p = 0.013). Pelvic version changed from 15.2° (-10.4° to 43.8°) to 17.2° (-6° to 46.7°; p = 0.008). Pelvic inclination was 1.12° (-25.9° to 24°) before THA and -1.2° (-40.7° to 23.4°) postoperatively (p = 0.005). Conclusions The acetabular and femoral implant orientations in standing position reside out of the safe zone in most patients. The APP is not vertical in standing position in most patients due to anterior or posterior pelvic tilt. The proposed safe zone in supine position may not be a useful measure in the assessment of standing radiographs of patients with significant anterior or posterior pelvic tilt.
Abstract The goal of this meta-analysis was to evaluate the efficacy of venous foot pumps in prevention of venous thromboembolism following joint arthroplasty. Using different databases, we found 13 ...prospective clinical trials published meeting our inclusion criteria. In total, 1514 patients were included in the final analysis. Venous foot pump devices are effective in prevention of venous thromboembolic disease after total hip and knee arthroplasty compared to chemoprophylaxis. This was especially significant in prevention of major deep vein thrombosis and pulmonary emboli rate. The use of mechanical devices like venous calf or foot pump, either alone or in combination with less potent chemical prophylaxis, on the other hand can reduce the rate of venous thromboembolism and complications of potent chemoprophylaxis like wound hematoma.
Abstract Background This study compared two- and three-dimensional (2D and 3D) radiographic measurements of anatomical and functional leg length and knee coronal and sagittal alignments, and ...correlated these measurements with patients’ leg-length perceptions. Methods Patients without symptomatic spinal pathology, previous surgery of the spine and lower extremities (140 lower extremities) were evaluated on EOS® images obtained in standing position. Numerous measurements of each limb were compared to the contralateral limb. All 2D/3D measures were evaluated and compared for repeatability and reproducibility. Results Mean 2D functional and anatomical lengths were 78.7 cm (64.7-88.4, CI 95%: 77.4-80) and 78.3 cm (64.9-87.9, CI 95%: 77-79.6), respectively. Mean 3D functional and anatomical lengths were 78.9 cm (65.1-88.7, CI 95%: 77.6-80.2) and 78.9 cm (65.6-88.3, CI 95%: 77.8-80.5), respectively (p < 0.001). Mean 2D and 3D knee varus/valgus angles were -1.9 ° (-26.4-9.1, CI 95%: -3.5 to -0.7) and -0.9 ° (-19.2-11.8, CI 95%: -2.4-0.2), respectively (p = 0.004). Multiple regression analysis found that patients with >10° of flexum/recurvatum were 2.1× more likely to perceive unequal length (p < 0.1). Patients with irreducible varus/valgus knee deformity were 4× more likely to perceive unequal length (p < 0.04). Conclusions EOS® imaging allows more accurate assessment of anatomical and functional lengths. Patients’ perceptions of lower extremity length may correlate more closely with coronal and sagittal alignments of the knee than with femoral or tibial length. This study highlights the importance of physical examination of all the joints and 3D measurements in functional standing position.
Sagittal spinopelvic translation (SSPT) is the horizontal distance from the hip center to the C7 plumb line (C7PL). SSPT is an important variable showing the overall patient balance in different ...functional positions which could affect the rate of hip instability. This study investigates the SSPT modification in patients who underwent total hip arthroplasty (THA).
A total of 120 patients were assessed preoperatively and postoperatively on standing and sitting acquisitions (primary unilateral THA without complication). SSPT is zero when the C7PL goes through the center of the femoral heads and positive when the C7PL is posterior to the hips’ center (negative if anterior). Three subgroups were defined based on the pelvic incidence (PI): low PI <45°, 45°< normal PI <65°, or high PI >65°.
The overall mean preoperative SSPT change from standing to sitting was 2.2 cm (-7.2 to 17.4) (P < .05). The overall mean postoperative SSPT change from standing to sitting was 1.2 cm (-14.2 to 22.4) (P < .05). In low- and normal-PI groups, standing to sitting SSPT and preoperative to postoperative changes in standing SSPT were increased significantly after surgery with the C7PL behind the hips’ center (P < .05). In the high-PI group, standing to sitting SSPT was increased postoperatively (P = .034) (no significant changes from preoperative to postoperative status in standing and sitting).
Adaptation from standing to sitting positions combines pelvic tilt and anteroposterior pelvic translation. THA implantation induces significant changes in SSPT mainly for low- and standard-PI patients. This is an important variable to consider when investigating the causes of THA subluxation or dislocation.
Many of the current total hip arthroplasty (THA) planning tools only consider sagittal pelvic tilt in the standing and relaxed sitting positions. Considering that the risk of postoperative ...dislocation is higher when bending forward or in sit-to-stand move, sagittal pelvic tilt in the flexed seated position may be more relevant for preoperative planning. We hypothesized that there was a significant difference in sagittal pelvic tilt between the relaxed sitting and flexed seated positions as measured by the sacral slope in preoperative and postoperative full-body radiographs.
This was a multicenter retrospective analysis of the preoperative and postoperative simultaneous biplanar full-body radiographs of 93 primary THA patients in standing, relaxed sitting, and flexed seated positions. The sagittal pelvic tilt was measured using the sacral slope relative to the horizontal line.
The mean difference between the preoperative sacral slope in the relaxed sitting position and the flexed seated position was 11.3° (−13° to 43°) (P < .0001). This difference was >10° in 52 patients (56%) and >20° in 18 patients (19.4%). The mean difference between the postoperative sacral slope in a relaxed sitting position and the sacral slope in a flexed seated position was 11.3° (P < .0001). This difference was >10° in 51 patients (54.9%) and >30° in 14 patients (15.1%) postoperatively.
There was a significant difference in sagittal pelvic tilt between the relaxed and flexed seated positions. A flexed seated view provides valuable information that might be more relevant for preoperative THA planning in order to prevent postoperative THA instability.
PDF
